A Dose of Their Own Medicine

A Dose of Their Own Medicine

By Oliver Del Signore

Oliver Del Signore
August 12, 2001

Anyone who has ever had to deal with a public servant at any level of government knows what a frustrating experience it can be. It is bad enough when you want to get something accomplished, but it can approach the nightmarish when they summon you for questioning.

Whenever a government official asks you a question, and you answer, you place yourself and all you own at risk. The wrong answer could cause the official to initiate all manner of nasty investigations requiring you to invest countless hours and unlimited funds in an often vain attempt to satisfy them and their rules. What can you do?

Allen, a reader with an Australian email address, may have come up with the answer. He recently sent me the following Public Servant questionnaire. I thought it clever, at first, but the more I thought about it, I realized just how practical and useful it can be. Included with the questionnaire were some simple instructions:

When handing this form to a public servant, you must remember never to refuse to co-operate, only on the condition they fill out the question page first.

They will want to know why you want it. You need it in case you are charged with an offense. You need the public servant’s name and address because you can’t serve a summons to their place of work and you will need to recover any costs if there is a court case.

Yes, I think Allen has hit on something here. It is high time the good citizens of these United States started giving our servants a dose of their own medicine.

Here’s the questionnaire, with some modifications and formatting. Feel free to share it and use it as you see fit.

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Public Servant Questionnaire

1a. Name and title of public servant:
1b. Residence address:
1c. City, State, Zip Code:

2a .Full name of government department, bureau, or agency by which public servant is employed
2b. Mailing address:
2c. City, State, Zip Code:
2d. Telephone number:

3a. Supervisor’s name and title:
3b. Mailing address:
3c. City, State, Zip Code:
3d. Telephone number:

4. Will public servant uphold the PRIVACY and FREEDOM OF INFORMATION ACTS?   Yes  No  (circle answer)

5a. Will public servant furnish proof of identity?   Yes  No  (circle answer)

5b. Nature of proof provided? I.D./Employee/Badge No.:
5c. Other (List details):

6. Will public servant furnish a copy of the laws or regulations which authorize this investigation prior to proceeding?   Yes  No  (circle answer)

7. Are the questions to be asked based upon a specific law or regulation?   Yes  No  (circle answer)

8. Will the public servant read aloud the portion of the law authorizing the questions he/she will ask ?   Yes  No  (circle answer)

9. Are/will answers given be used as/in a discovery process?   Yes  No  (circle answer)

10a. Are the answers voluntary or mandatory?   Voluntary  Mandatory  (circle answer)

10b. If mandatory, list penalties for non-compliance. If voluntary, list any possible effects upon me, my real property and my personal property if I should choose to not answer any part or all of the questions.

11. What other uses may be made of this information?

12. What other agencies may have access to this information?

13a. Name and title of the person in the Government requesting/ordering this investigation:
13b. Mailing address:
13c. City, State, Zip Code:
13d. Telephone number:

14. Circle the nature of this investigation:   General  Special
Note: “General” means any kind of blanket investigations in which a number of persons are involved for any reason. Special means any investigation of an individual nature in which others may or may not be involved.

15. Provide complete details of the investigation or inquiry.

16a. Have you consulted, questioned, interviewed, or received information from a third party, relative to this investigation?   Yes  No  (circle answer)
16b. If yes, list the identity of all such third parties including name, mailing address and telephone number.

17a. Do you anticipate civil or criminal action to be pursued based upon any of the information that you seek?   Yes  No  (circle answer)
17b1. If yes, which action:   Civil  Criminal  (circle answer)
17b2. If civil, list possible claims:
17b3. If criminal, list possible charges and penalties:

18a. Is there a file of records, information or correspondence relating to me being maintained by this agency?   Yes  No  (circle answer)
18b1. If yes, will public servant provide me access to the records, information or correspondence for the purpose of my reviewing them for accuracy prior to commencement of questioning?   Yes  No  (circle answer)
18b2. If yes, provide details of how and when access will be provided. If no, list reasons for denial of access.

19a. Is the public servant and/or public servant’s department, bureau, or agency using information pertaining to me, which was supplied, by another agency or Government source?   Yes  No  (circle answer)
19b. If yes, which agency or source? Include agency/source name, mailing address, and telephone number.

20a. Will the public servant guarantee that the information in these files will not be used by any other department other than the one by which he/she is employed?   Yes  No  (circle answer)
20b. If no, detail reason(s) for refusal:

Signed under penalties of perjury this _________day of ___________, 20____.

Public Servant (Print Name):

Public Servant Signature:

Public Notary or Justice of the Peace

Witness (Print Name and Title):

Witness (Signature):

Witness Seal or Stamp (If applicable in jurisdiction):


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